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Counselor Check-In
Please let me know how you are doing. For younger children, please complete this form together. For older children, this form can be completed independently.
* Indicates required question
Email
*
Your email
LAST NAME, FIRST NAME
*
Your answer
CLASSROOM TEACHER
*
Your answer
How are you feeling?
*
I am happy!
I am sleepy.
I am upset.
I am silly!
I am sick.
I am sad.
I am nervous.
Other:
HOW DID YOU FEEL TODAY?
*
I was my best self.
I gave it my all.
I will try harder tomorrow.
DESCRIBE HOW BEING HOME HAS BEEN FOR YOU IN 5 WORDS OR LESS.
Your answer
DO YOU HAVE ANYTHING TO TELL ME OR ANYTHING YOU WANT TO SHARE WITH ME OR ASK ABOUT? FOR EXAMPLE...SOMETHING ABOUT SCHOOL, OR FRIENDS, OR ANOTHER QUESTION.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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